ABSTRACT
Objective:To construct a comprehensive community management platform for prevention and treatment of chronic obstructive pulmonary disease (COPD) and evaluate its effectiveness and feasibility in the prevention and treatment of COPD.Methods:A comprehensive community management platform for prevention and treatment of COPD was established based on the information network. The platform mainly includes COPD screening, establishment of electronic health files of COPD patients living in the community, and hierarchical management of COPD patients. Patients who met COPD criteria were admitted by two community health centers (control and study groups, n = 1 000/group) with similar environments. In the control group, comprehensive community management platform for prevention and treatment of COPD was not established, and only diagnosis and conventional treatment were performed. In the study group, comprehensive community management platform was established to screen COPD patients, establish electronic health files of COPD patients, and hierarchically manage the COPD patients. All patients were followed up for 1 year. The number of acute exacerbations of COPD, treatment cost, the improvement in pulmonary function, dyspnea, and quality of life were compared between the two groups. The effects of the established comprehensive community management platform on prevention and treatment of COPD were analyzed. Results:One-year follow-up results revealed that an acute exacerbation of COPD occurred in 578 patients from the control group and 326 patients from the study group. The proportion of an exacerbation of COPD, the number of exacerbations of COPD, treatment cost in the study group were 32.60% (326/1 000), (1.52 ± 0.58), (2 014.21 ± 122.29) yuan, respectively, which were significantly lower than those in the control group [57.80% (578/1 000), (2.28 ± 2.15), and (4 201.34 ± 210.25) yuan, t = 12.34, 3.19, 21.24, all P < 0.05]. Before establishment of the comprehensive community management platform, there were no significant differences in pulmonary function, modified Medical Research Council (mMRC) dyspnea score, COPD assessment test (CAT) score between the two groups (all P > 0.05). In the control group, the ratio of forced expiratory volume in 1 second (FEV 1)/forced vital capacity (FVC), predicted FEV 1 value, mMRC dyspnea score, and CAT score were (60.32 ± 12.31)%, (63.65 ± 9.37)%, (1.89 ± 1.01) points, (18.82 ± 5.35) points, respectively after 1 year of treatment. There were no significant differences in these indexes between before and after 1 year of treatment ( t = 0.79, 0.87, 1.05, 0.83, all P > 0.05). In the study group, FEV 1/FVC ratio, predicted FEV 1 value, mMRC dyspnea score, and CAT score were (65.27 ± 13.59)%, (68.92 ± 10.67)%, (1.41 ± 0.72) points, (13.24 ± 5.21) points, respectively after 1 year of treatment. Significant differences in these indexes were found between before and after 1 year of treatment ( t = 3.28, 3.39, 4.17, 5.71, all P < 0.05). Conclusion:The established comprehensive community management platform is highly effective for prevention and treatment of COPD. It can effectively reduce the frequency of acute exacerbations of COPD, reduce treatment cost, improve pulmonary function, alleviate dyspnea, and improve quality of life.
ABSTRACT
Objective To explore the application of procalcitonin (PCT) and C-reactive protein (CRP) detection in acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and its guiding value in the use of antimicrobial agents.Methods From June 2014 to June 2018,82 patients with AECOPD treated in the Third People's Hospital of Yuyao were selected.According to the difference of PCT and CRP levels at admission,the patients were divided into three groups:A,B and C group.A group (n =17):the serum PCT level was less than 0.10μg/L,treated with phlegm and asthma relief and symptomatic therapy without antibiotic therapy.B group (n =33):the serum PCT level was 0.10-0.25 μg/L,B group was not treated with antibiotics,if the level of PCT≥0.25 μg/L on the next day or the amplitude of increase ＞ 30％,the treatment method was the same as that in C group.C group (n =32):the serum PCT level was more than 0.25 μg/L,C group was given expectoration and asthma relief,symptomatic treatment and antibiotics.The clinical data,laboratory test indicators and clinical efficacy of the three groups were compared.Results There were no statistically significant differences in the general clinical data of the three groups (all P ＞0.05).The incidence of fever in the three groups were 2 cases (11.76％),16 cases (50.00％) and 19 cases (57.58％),respectively;expiratory dyspnea in the three groups were 6 cases (35.29％),25 cases (78.13％),31 cases (93.94％),respectively;wheezing rale in the three groups were 4 cases (23.53％),26 cases (81.25％),33 cases (100.00％),respectively;wet sound in the three groups were 12 cases (70.59％),27 cases (84.37％),33 cases (100.00％),respectively,the differences of the above indicators among the three groups were statistically significant(x2 =15.827,24.361,30.284,18.644,all P ＜ 0.05).The percentages of sputum positive patients in the three groups were 4 cases (23.53 ％),10 cases (31.25 ％) and 23 cases (69.69％),respectively;the percentages of sputum culture positive patients were 5 cases (29.41％),24 cases (75.00％),28 cases (84.85 ％),respectively,the differences of the above indicators among the three groups were statistically significant (x2 =16.871,24.644,all P ＜ 0.05).The WBC counts of the three groups were (4.27 ± 1.92) × 109/L,(8.64 ± 3.77) × 109/L,(18.06 ±4.87) × 109/L,respectively;the ratios of neutrophils were (54.12 ± 3.48),(82.19 ±5.67),(90.07 ± 9.33),respectively;the levels of PCT of the three groups were (0.09 ±0.08) μg/L,(0.21 ±0.12) μg/L,(0.74 ±0.33) μg/L,respectively,there were significant differences in WBC count,ratio of neutrophils and PCT among the three groups (F =14.827,25.825,19.873,all P ＜ 0.05).The level of CRP among the three groups had no statistically significant difference (P ＞ 0.05).Patients in A group were not treated with antimicrobial agents and their clinical symptoms were improved.Fourteen patients without antimicrobial agents and 18 patients with improved clinical symptoms were treated with antimicrobial agents in B group.In C group,20 patients with symptoms improved after treatment with antimicrobial agents,12 patients with replacement of antimicrobial treatment regimen and 1 patient died.Conclusion PCT and CRP can be used as an index to evaluate the severity of AECOPD and a reference tool for the use or replacement of antimicrobial agents.
ABSTRACT
Objective@#To explore the application of procalcitonin (PCT) and C-reactive protein(CRP) detection in acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and its guiding value in the use of antimicrobial agents.@*Methods@#From June 2014 to June 2018, 82 patients with AECOPD treated in the Third People's Hospital of Yuyao were selected.According to the difference of PCT and CRP levels at admission, the patients were divided into three groups: A, B and C group.A group (n=17): the serum PCT level was less than 0.10μg/L, treated with phlegm and asthma relief and symptomatic therapy without antibiotic therapy.B group (n=33): the serum PCT level was 0.10-0.25 μg/L, B group was not treated with antibiotics, if the level of PCT≥0.25 μg/L on the next day or the amplitude of increase≥30%, the treatment method was the same as that in C group.C group (n=32): the serum PCT level was more than 0.25 μg/L, C group was given expectoration and asthma relief, symptomatic treatment and antibiotics.The clinical data, laboratory test indicators and clinical efficacy of the three groups were compared.@*Results@#There were no statistically significant differences in the general clinical data of the three groups (all P>0.05). The incidence of fever in the three groups were 2 cases (11.76%), 16 cases (50.00%) and 19 cases (57.58%), respectively; expiratory dyspnea in the three groups were 6 cases (35.29%), 25 cases (78.13%), 31 cases (93.94%), respectively; wheezing rale in the three groups were 4 cases (23.53%), 26 cases (81.25%), 33 cases (100.00%), respectively; wet sound in the three groups were 12 cases (70.59%), 27 cases (84.37%), 33 cases (100.00%), respectively, the differences of the above indicators among the three groups were statistically significant(χ2=15.827, 24.361, 30.284, 18.644, all P<0.05). The percentages of sputum positive patients in the three groups were 4 cases (23.53%), 10 cases (31.25%) and 23 cases (69.69%), respectively; the percentages of sputum culture positive patients were 5 cases (29.41%), 24 cases (75.00%), 28 cases (84.85%), respectively, the differences of the above indicators among the three groups were statistically significant(χ2=16.871, 24.644, all P<0.05). The WBC counts of the three groups were (4.27±1.92)×109/L, (8.64±3.77)×109/L, (18.06±4.87)×109/L, respectively; the ratios of neutrophils were (54.12±3.48), (82.19±5.67), (90.07±9.33) , respectively; the levels of PCT of the three groups were (0.09±0.08) μg/L, (0.21±0.12) μg/L, (0.74±0.33) μg/L, respectively, there were significant differences in WBC count, ratio of neutrophils and PCT among the three groups (F=14.827, 25.825, 19.873, all P<0.05). The level of CRP among the three groups had no statistically significant difference (P>0.05). Patients in A group were not treated with antimicrobial agents and their clinical symptoms were improved.Fourteen patients without antimicrobial agents and 18 patients with improved clinical symptoms were treated with antimicrobial agents in B group.In C group, 20 patients with symptoms improved after treatment with antimicrobial agents, 12 patients with replacement of antimicrobial treatment regimen and 1 patient died.@*Conclusion@#PCT and CRP can be used as an index to evaluate the severity of AECOPD and a reference tool for the use or replacement of antimicrobial agents.